Job Description
POSITION SUMMARY:
The Compliance Auditor supports the Chief Compliance Officer (CCO) to ensure the Pharmacy’s adherence to federal and state laws, regulations, industry standards, and guidelines affecting patient services, operations, and business transactions. This position works collaboratively with departments throughout the organization as directed by the CCO to support, maintain, and improve compliance, operational, and quality standards.
ESSENTIAL FUNCTIONS:
- Performs periodic internal compliance audits on at least a quarterly basis throughout the calendar year to examine adherence to legal, operational, financial, and policy requirements.
- Conducts compliance monitoring activities on an ongoing basis as instructed by the CCO or Executive Leadership.
- Conduct audits concentrating on medical billings, claims payments, and financial data.
- Documents and reports all corporate compliance violations to CCO and/or Executive Leadership during the course of conducting audit inquiries, questions, and investigations, and on an ongoing basis thereafter, as required.
- Assists or leads Department efforts to examine or identify operational or compliance indicators, trends, or problems, as assigned.
- Conducts interviews with department staff as required.
- Conducts Root Cause Analysis, as needed, during compliance audits, monitoring, investigations, or inquiries, as required.
- Collaborates with all staff, IT, and other stakeholders as required, on all targeted compliance audits in order to meet applicable legal and industry requirements.
- Drafts final audit report findings and observations with recommendations to the CCO.
- Serves as a subject matter resource/liaison regarding compliance audits conducted by the Compliance Auditor.
- Supports all functions related to Compliance Department internal/external reporting activities.
- Supports the CCO in the administration of the BioPlus compliance program and objectives.
- Actively supports BioPlus Core Values and Mission through professional behavior and daily job performance
OTHER DUTIES:
- Participate and perform other duties as assigned by leadership
COMPETENCY:
- Knowledge of standard medical/pharmaceutical terminology
- Proficiency with medical billings, claims, and financial data
- Knowledge of deductibles, copays, and coinsurance.
- Ability to learn quickly, solve problems, and make recommendations.
- Working knowledge of Adobe and CPR+ (preferred)
- Ability to run, read and analyze reports and statistical data.
- Ability to work cooperatively and handle multiple projects.
- Demonstrate excellent oral, presentation, and written communication skills
- Demonstrate proficiency in the use of MS Office software; which includes Excel, Word and Outlook
- Demonstrate the BioPlus C.A.R.T. values;
o Competence
o Accountability
o Respect
o Trust